Proximal gastric response to small intestinal nutrients is abnormal in mechanically ventilated critically ill patients

瞄准：在非常有病的病人决定近似的胃的反应到小肠的营养素。方法：近似胃的活动性在 13 个非常有病的病人被测量(49.3 +/- 4.7 年) 并且 12 个健康志愿者(27.7 +/- 2.9 年) 用一种 barostat 技术。记录在基线被执行，在 60-min 期间 intra 十二指肠的注入保证(2 kcal/min ) ，并且为跟随注入的 2 h。最小的扩张压力(MDP ) ， intra 袋子体积和底的波浪活动是坚定的。结果：MDP 在病人是更高的(11.7 +/- 1.1 对 7.8 +/- 0.7 毫米汞柱；P 【 0.01 ) 。基线 intra 袋子体积在 2 个组是类似的。在健康题目，一“双性人形式”近似胃的体积反应被观察。在病人，近似胃的体积的起始的增加小、推迟，但是最后到达了类似于健康题目的最大的体积。在健康题目，近似胃的体积很快在滋养的注入以后回到了基线水平(中部 18 min ) 。相反，到基线的体积的恢复在非常有病的病人被推迟(中部 106 min ) 。在 6 个病人，体积没在滋养的注入以后回到基线水平 2 小时。在病人，底的体积波浪是不太经常的(P 【 0.05 ) 并且有的更低的振幅(P 【 0.001 ) ，与健康题目相比。结论：在重病，对小肠的滋养的刺激的近似胃的马达回答是反常的。

AIM： To determine the response of the proxima stomach to small intestinal nutrients in critically ill patients. METHODS： Proximal gastric motility was measured in 13 critically ill patients （49.3 ± 4.7 years） and 12 healthy volunteers （27.7 ± 2.9 years） using a barostat technique. Recordings were performed at baseline, during a 60-rain intra-duodenal infusion of Ensure^R （2 kcal/min）, and for 2 h following the infusion. Minimum distending pressure （MDP）, intra-bag volume and fundic wave activity were determined. RESULTS： The MDP was higher in patients （11.7 ± 1.1 vs 7.8 ± 0.7 mmHg; P 〈 0.01）. Baseline intrabag volumes were similar in the 2 groups. In healthy subjects, a ‘bimodal＇ proximal gastric volume response was observed. In patients, the initial increase in proximal gastric volume was small and delayed, but eventually reached a maximal volume similar to that of healthy subjects. In healthy subjects, the proximal gastric volume rapidly returned to baseline level after nutrient infusion （median 18 min）. In contrast, the recovery of volume to baseline was delayed in critically ill patients （median 106 min）. In 6 patients, the volume had not returned to baseline level 2 hours after nutrient infusion. In patients, fundic volume waves were less frequent （P 〈 0.05） and had lower amplitude （P 〈 0.001）, compared to healthy subjects. CONCLUSION： In critical illness, proximal gastric motor responses to small intestinal nutrient stimulation are abnormal.